International Journal of Trend in Scientific Research and Development (IJTSRD)
Volume: 3 | Issue: 4 | May-Jun 2019 Available Online: www.ijtsrd.com e-ISSN: 2456 - 6470
Abdominal Compartment Syndrome: A Case Report
Femi Liz Babu1, Teena Thomas1, Alisha Maria Shaji2
1PHARM.D
(Doctor of Pharmacy) Interns, 2PHARM.D PB Intern
Medical College Hospital, Thiruvalla, Kerala, India
1,2Pushpagiri
How to cite this paper: Femi Liz Babu |
Teena Thomas | Alisha Maria Shaji
"Abdominal Compartment Syndrome: A
Case Report" Published in International
Journal of Trend in Scientific Research
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Issue-4, June 2019,
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ABSTRACT
Abdominal Compartment Syndrome (ACS) is a condition caused by abnormally
increased pressure within the abdomen. Fewer than 1 million cases per year
(India). Symptoms include a bloated abdomen, difficulty breathing or decreased
urination. Rapid management is very important to prevent death. In this case, a
thirty one year-old female without a similar history in the family, is presented
with this condition on the second day after delivery. This case report study has
been presented for the consideration of rare ACS in pregnant patients.
Keywords: Abdominal Compartment Syndrome, pregnancy, CVP line
INTRODUCTION
Compartment syndrome describes increased pressure within a muscle
compartment of the arm or leg. It is most often due to injury, such as fracture, that
causes bleeding in a muscle, which then causes increased pressure in the muscle.
This pressure increase causes nerve damage due to decreased blood supply. The
abdominal compartment syndrome represents the path physiologic consequence
of a raised intra-abdominal pressure. ACS is defined as a sustained IAP >20 mm
Hg associated with organ dysfunction/failure. Various clinical conditions are
associated with this syndrome and include massive intra-abdominal or
retroperitoneal hemorrhage, severe gut edema or intestinal obstruction, and
ascites under pressure. One should always consider the abdominal compartment
syndrome when confronted with acute circulatory failure with wide systolic–
diastolic pressure variation and elevated filling pressures[1]. However, relatively
little is known about the impact of intra-abdominal pressure
(IAP) in general internal medicine, pregnant patients, and
those with obesity or burns[2]. IAH in pregnancy must take
into account the precautions for aorto-caval compression
and has been associated with ovarian hyper stimulation
syndrome.
Three categories of ACS:
Primary or acute abdominal compartment syndrome
occurs when intra-abdominal pathology is directly and
proximally responsible for the compartment syndrome
Secondary abdominal compartment syndrome occurs
when no visible intra-abdominal injury is present but
injuries outside the abdomen cause fluid accumulation
Chronic abdominal compartment syndrome occurs in
the presence of cirrhosis and ascites or related disease
states, often in the later stages of the disease
CASE REPORT
A 31 year old female patient was admitted under OBG III.
ELECTIVE LSCS under SAB on the basis of previous LSCS.
Delivered a live term female baby of weight 2.730 kg. APGAR
on same day. Family history. Mother – DM on OHA and father
is hypertensive patient. The patient is allergic to Rantidine
and Cefazolin.
On postoperative day (POD) 2, patient developed severe
breathlessness, tachypnoea, tachycardia, facial puffiness,
abdominal distension and decreased urine output, hence
emergency general medicine consultation was sought in
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view of the same and their orders were carried out.
Emergency UGS abdomen scan taken and the findings are as
follows: mild to moderate ascites noted. Patient was shifted
to medical icu and was monitored. Next USG abdomen
showed moderate hem peritoneum, also the presence of free
fluid with internal echoes in sub hepatic, perisplenic regions
and in bilateral paracolic gutters as well as in pelvis.
Investigation repeated showed severe anemia with fall in Hb.
3 pint PRBS transfusion was done and Hb was monitored
Q6h until stable. Surgery consultation was sought and they
gave an impression of abdominal compartment syndrome
and d hence abdominal girth and intra-abdominal pressure
was monitored regularly. CVP line was inserted on POD 2.
Nephrology consultation was sought for decreased urine
output, they gave an impression of transient oliguria.
Cardiology consultation was sought to rule out LV
dysfunction. ECHO was done and was found to have stable
cardiac status. Next USG abdomen : organised echoes are
noted in right paracolic gutter extending to the region of
umbilicus and also in perisplenic area –could represent
organised clots – has reduced compared to previous scan. No
free fluid in the abdomen. Gradually, patient improved
symptomatically, hence shifted out to ward after removing
catheter and CVP line. Patient was noted to have
discoloration over the left iliac fossa and left lumbar region
which was managed with ichthammol glycerine and
chymoral forte. Follow up USG abdomen: hematoma in the
perihepatic, perisplenic and periumbilical region shows
resolution and approximately measures 390ccc at present.
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Per operative findings: dense adhesions between the rectus
sheath and anterior abdominal wall. Both ovaries and tubes
were adherent to the posterior surface of the uterus. Bowel
adhesions were present to the posterior surface of uterus.
DISCUSSION
In the second and the third trimester of pregnancy, the
uterus occupies a major part of the abdominal cavity, and in
the supine position breathlessness and decreased blood
pressure (“supine hypotension syndrome”) are often
seen[3,4]. The expansion of intra-abdominal contents in the
form of fluid or tissue is the fundamental cause of increasing
IAP leading to the path physiology of IAH and ACS.
Pregnancy, with a growing fetus and the increases in intraabdominal fluid and tissue, could be considered a perfect
storm for the development of IAH/ACS. Due to baseline
increases in IAP, all critically ill obstetrical/gynecologic
patients should undergo vigilant IAP monitoring. As
intraabdominal pressure rises, progressive organ failure
occurs. The kidneys and lungs are the most affected[5]. The
mortality rate associated with abdominal compartment
syndrome is significant, ranging between 60% and 70%[6,7,8].
CONCLUSION
At the cellular level of this syndrome, oxygen delivery is
impaired, leading to ischemia and anaerobic metabolism.
Vasoactive substances such as histamine and serotonin
increase endothelial permeability; further capillary leakage
impairs red cell transport; and ischemia worsens. As
pressure rises, abdominal compartment syndrome impairs
not only visceral organs but also the cardiovascular and the
pulmonary systems; it may also cause a decrease in cerebral
perfusion pressure. IAP can be easily monitored by
measuring bladder pressure. Cheatham et al found
abdominal perfusion pressure (APP) to be a much better
predictor of end-organ injury than lactate, pH, urine output,
or base deficit[9]. Therapy should include fluid resuscitation
and transfusion if needed, as well as surgical consultation. A
comprehensive, evidence-based approach to the
management of abdominal compartment syndrome that
includes early use of an open abdomen has been shown to
reduce mortality[10]. A group in Taiwan has used
laparoscopic decompression successfully in blunt abdominal
trauma patients who have an IAP of 25-35 cm H2O[11]. The
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timely diagnosis and appropriate management of ACS in this
patient helped her to recover completely.
REFERENCE
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Crit Care 1999, 3:R103–R104
[2] Anaesthesiology Intensive Therapy 2015, vol. 47, no 3,
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[3] Chun R, Kirkpatrick AW: Intra-abdominal pressure,
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[9] Cheatham ML, White MW, Sagraves SG, et al.
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[10] Cheatham ML, Safcsak K. Is the evolving management
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[11] Chen RJ, Fang JF, Lin BC, Kao JL. Laparoscopic
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